An article published in Spine examines the results of revision spine surgery after pedicle subtraction osteotomy for fixed sagittal imbalance with pseudarthrosis.
The researchers examined 18 consecutive patients with pseudarthrosis after pedicle subtraction osteotomy treated with revision surgery. The researchers found:
1. The patient's sagittal vertical axis and lumbar lordosis improved significantly postoperatively. The improvement was maintained until the final follow-up. The minimum follow-up for patients in this study was five years.
2. After the second procedure, the patients maintained correction from the primary surgery in:
• Proximal junction angle
• Thoracic kyphosis
• Pedicle subtraction osteotomy angle
The surgeons increased the number of rods and/or changed the rods to 6.35 mm diameter in all patients.
3. Patients experienced significant improvement in Oswestry Disability Index scores. Scores improved from 37.9 to 45 postoperatively. The Scoliosis Research Society pain subscale also improved to 2.6 from 3.1 after the procedure.
4. There was a trend toward poor ODI and SRS scores in patients with pelvic incidence greater than 60 degrees. There was not improvement in the total SRS score or other subscales beyond the pain subscale.
5. There were no significant differences between SVA greater or less than 11 cm. "Successful surgical outcomes may be achieved by using an increased number or size of implants and ample bone graft for complete fusion after revision surgery," concluded the study authors.